CAJ | 학술논문

目的：探讨非气腹无腹壁辅助切口完全腹腔镜直肠癌全直肠系膜切除术的临床应用价值。方法2010年2月～2013年10月对35例直肠癌行非气腹无腹壁辅助切口完全腹腔镜全直肠系膜切除术。在脐上做1．5～2．0 cm切口，置入腹腔镜后在脐下2 cm、耻骨上5 cm各平行横向置入钢针进行悬吊，用固定于手术床左侧的悬吊装置提拉腹壁，显露手术操作区域。将吻合器钉座自肛门利用引导丝置入肿瘤近侧结肠，自结肠壁戳孔引出吻合器钉座拉杆，腹腔镜下切割闭合器离断距离钉座3 cm结肠，远侧带瘤肠管内翻经肛门拖出、切除，残端缝合后还纳，自肛门插入吻合器杆，腹腔镜下行结直肠或结肠肛管吻合。结果35例手术均成功，无中转开腹。手术时间150～230 min，平均180 min；术中出血量40～110 ml，平均55 ml。术后30～50 h，平均48 h胃肠功能恢复。术后住院5～8 d，平均6 d。术后病理：高分化腺癌12例，中分化腺癌16例，低分化腺癌7例，远近切缘均无肿瘤残留。35例随访7～51个月，平均21个月，无明显排尿困难和性功能障碍，排便习惯正常，1～2次/d，28例CT、MRI检查无复发和转移，trocar口无肿瘤种植，无肠梗阻发生。结论非气腹无腹壁辅助切口完全腹腔镜直肠癌全直肠系膜切除术避免气腹对人体血流动力学的影响，无腹壁辅助切口，是一种安全、可行、经济的手术方法，值得临床推广。
목적：탐토비기복무복벽보조절구완전복강경직장암전직장계막절제술적림상응용개치。방법2010년2월～2013년10월대35례직장암행비기복무복벽보조절구완전복강경전직장계막절제술。재제상주1．5～2．0 cm절구，치입복강경후재제하2 cm、치골상5 cm각평행횡향치입강침진행현조，용고정우수술상좌측적현조장치제랍복벽，현로수술조작구역。장문합기정좌자항문이용인도사치입종류근측결장，자결장벽착공인출문합기정좌랍간，복강경하절할폐합기리단거리정좌3 cm결장，원측대류장관내번경항문타출、절제，잔단봉합후환납，자항문삽입문합기간，복강경하행결직장혹결장항관문합。결과35례수술균성공，무중전개복。수술시간150～230 min，평균180 min；술중출혈량40～110 ml，평균55 ml。술후30～50 h，평균48 h위장공능회복。술후주원5～8 d，평균6 d。술후병리：고분화선암12례，중분화선암16례，저분화선암7례，원근절연균무종류잔류。35례수방7～51개월，평균21개월，무명현배뇨곤난화성공능장애，배편습관정상，1～2차/d，28례CT、MRI검사무복발화전이，trocar구무종류충식，무장경조발생。결론비기복무복벽보조절구완전복강경직장암전직장계막절제술피면기복대인체혈류동역학적영향，무복벽보조절구，시일충안전、가행、경제적수술방법，치득림상추엄。
Objective To investigate the application value of gasless laparoscopic total mesorectal excision for rectal cancer without auxiliary incision . Methods From February 2010 to October 2013, 35 cases of colorectal cancer underwent gasless laparoscopic total mesorectal excision without auxiliary incision .On the umbilicus a 1.5-2.0 cm incision was made into the abdomen . Steel needles were parallel horizontally introduced at 2 cm below the umbilicus and 5 cm above the pubic bone for suspension .The hanging device on the left side of the operating table was used for electing abdominal wall to show operation area .By using a guide wire, the nail seat was put via the anus to colon tumor .The stapling nail pull rod was pulled out through the bowel wall .Under laparoscopic vision , the lesion was resected 3 cm from the margin by using an endo-cutting device .The distal intestinal canal with tumor was dragged out and removed from the anus .The residual stum was sutured .The stapling pole was inserted from the anus for laparoscopic downward colorectal or colon anal anastomosis . Results All the 35 cases were performed successfully .No conversion to laparotomy was needed .The operation time was 150-230 min, with an average of 180 min.The intraoperative blood loss was 40-110 ml, with an average of 55 ml.At 30-50 postoperative hours (mean, 48 h), gastrointestinal functions recovered .Postoperative hospital stay was 5-8 d, with an average of 6 d.Postoperative pathology confirmed that there was no residual tumor at the resection margin.All the 35 cases were followed up for 7-51 months, with an average of 21 months.No obvious dysuria and sexual dysfunction occurred.The bowel movement was normal, 1 -2 times of defecation daily.Imaging examinations showed no recurrence and metastasis, no trocar port tumors, and no intestinal obstruction in 28 cases. Conclusion Gasless laparoscopic total mesorectal excision for rectal cancer without auxiliary incision is a safe , feasible and economic operation method , being worthy of clinical promotion.